This Green Paper aims to initiate a debate on the health workforce in the European Union, with a view to reinforcing their numbers and training them. It will try to take into account their increasing mobility, the new needs of an ageing population and the increasing role of new technologies.

ACT

Green Paper from the Commission of 10 December 2008 on the health workforce [COM(2008) 725 final – Not published in the Official Journal].

SUMMARY

This Green Paper examines the challenges that the European Union (EU) must tackle at present with regard to its health workforce, and suggests some adapted solutions with a view to public consultation on this subject.

Legal framework and basis for action at Community level

Although Member States are responsible for the organisation and provision of health services and medical care, the Treaty establishing the European Community (EC Treaty) provides for a certain level of coordination at Community level. Moreover, secondary legislation defines the rules that are applicable at national level, including some applying to the health workforce, and in particular in terms of labour law.

Challenges faced by the health workforce

Medical staff and all the professions which contribute to organising and providing health care are considered by the Green Paper. The designation of health workforce includes, for example, public health specialists, social workers, trainers and alternative medicine.

Demography, a sustainable health workforce and public health capacity

European citizens are living longer and it is essential to guarantee their good health throughout their lifespan.

An ageing population implies an increase in the number of chronic conditions. The demand for health care is therefore increasing, whilst a considerable portion of the workforce required to meet these needs is approaching retirement age. Indeed, there is a lack of new health professionals able to replace them.

Moreover, inequalities in access to care, health promotion, and health and safety at work are determinants of public health, to which this workforce should pay increasing attention.

Training and information

If health needs multiply and the replacement of health staff is not guaranteed, more universities, training schools and teachers will be needed. It will also be important to plan which specialised skills will be the most necessary.

There is little comparable data or updated information about the health workforce and its mobility.

Mobility and migration of the health workforce

Mobility of health professionals has a dual effect. A positive effect because it can allow supply to be adapted to demand. Professionals can indeed go where they are most needed. This free circulation can also have negative effects in that it can create imbalances and inequalities in terms of availability of health staff.

A major problem is the phenomenon of the brain drain from third countries to the European Union. For this reason circular migration should be put in place.

To this end, in 2008, the European Social Dialogue Committee in the Hospital sector, composed of HOSPEEM (European Hospital and Healthcare Employers' Association) and the European Federation of Public Service Unions (EPSU), adopted a ‘code of conduct and follow up on Ethical Cross-Border Recruitment and Retention’. This measure aims to promote ethical practices when recruiting health workers.

New technologies and entrepreneurship

In the future, new technologies such as telemedicine may be able to counteract some deficiencies of the present health system. The introduction of new technologies represents certain challenges which the Green Paper proposes to meet by inviting Member States to:

guarantee training in the use of these new technologies;

encourage the use of new information technologies.

Some health workers run their own practices and employ staff. The European Union encourages this type of activity, all the more so since the creation of small and medium-sized enterprises contributes to the objectives of the Lisbon Strategy.

Some proposals made by the Green Paper

The Green Paper proposes several ways forward, pending the results of the public consultation on the health workforce. They include:

reconsidering the principles of recruiting staff from third countries;

collecting comparable information about health workers;

guaranteeing training for these workers in the use of these new technologies, amongst other skills;

further encouraging entrepreneurs to enter the health sector.

Context

This Green Paper aims to initiate a debate on the health workforce in the European Union. This debate could identify how to best promote and train the workforce and enable it to meet the current demographic, technological and migratory challenges. A public consultation was held between December 2008 and March 2009.